Sprain, Strain; Causes, Symptoms, Diagnosis, Treatment

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Sprain, Strain is the most common soft tissues injured are muscles, tendons, and ligaments. These injuries often occur during sports and exercise activities, but sometimes simple everyday activities can cause an injury. Sprains, strains, and contusions, as well as tendinitis and bursitis, are common soft-tissue injuries. Even with appropriate treatment, these injuries may require a prolonged amount of time to heal.

Foot  Sprain, Strain

Types of Foot  Sprain, Strain

  • Acute injuries – are caused by a sudden trauma, such as a fall, twist, or blow to the body. Examples of an acute injury include sprains, strains, and contusions.
  • Overuse injuries – occur gradually over time, when an athletic or other activity is repeated so often, areas of the body do not have enough time to heal between occurrences. Tendinitis and bursitis are common soft-tissue overuse injuries.
Table 1: Rearfoot pain
Location of pain A possible causes
Posterior aspect of the heel Sever’s disease/traction apophysitis
Duckbill fracture of the calcaneum
Haglund’s deformity
Insertional calcific Achilles tendinosis
Deep retrocalcaneal bursitis
Superficial retrocalcaneal bursitis
Achilles tendinitis
Partial rupture of Achilles tendon
Total rupture of the Achilles tendon
Blisters
Chilblain/perniosis
An inferior (plantar) aspect of heel Calcaneal fracture
Osteoid osteoma
Calcaneal spur
Baxter’s neuritis
Sero-negative and seropositive inflammatory joint disease
Plantar calcaneal bursitis (policeman’s heel; stone bruise; subcalcaneal bursitis)
Proximal plantar fasciitis
Proximal foot strain
S1 entrapment neuropathy/radiculopathy
Medial calcaneal nerve entrapment neuropathy
Corn/callosity
Verruca pedis
Medial aspect of the heel Deltoid ligament strain/sprain
Tibialis posterior tendinitis
Tibialis posterior rupture/partial rupture
Flexor hallucis longus tendinitis
Flexor digitorum longus tendinitis
Lateral aspect of the heel Lateral collateral ligament strain/sprain
Peroneus longus tendinitis
Peroneus Brevis tendinitis
Anterior aspect of the ankle Osteochondritis dissecans of the talus
Anterior impingement
Extensor reticulitis
Periphery of heel Heel fissures
Tinea pedis
Sprains

A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connect the end of one bone with another. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the thighbone with the shinbone, enabling people to walk and run.

The areas of your body that are most vulnerable to sprains are your ankles, knees, and wrists. A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee can be the result of a sudden twist, and a wrist sprain can occur when falling on an outstretched hand.

Sprains or strains are most likely to occur if you over-reach

  • change direction suddenly
  • slow down or accelerate suddenly
  • fall and land awkwardly
  • collide with an object
  • experience a blow to a joint

Ankle sprains can occur if you ‘go over’ onto the outside of your foot. This causes your whole body weight to press down suddenly on the outer ligament of your ankle which can stretch or tear it. Ankle sprains sometimes occur when walking or running over rough or uneven ground.

A twisting force to the lower leg or foot is a common cause of ankle sprains.
Reproduced from The Body Almanac.  American Academy of Orthopaedic Surgeons, 2003.

Sprains are classified by severity:

  • Grade 1 sprain (mild): Slight stretching and some damage to the fibers (fibrils) of the ligament.
  • Grade 2 sprain (moderate): Partial tearing of the ligament. There is abnormal looseness (laxity) in the joint when it is moved in certain ways.
  • Grade 3 sprain (severe): Complete tear of the ligament. This causes significant instability and makes the joint nonfunctional.

A sprain occurs when one or more of your ligaments have been stretched, twisted, or torn, usually as a result of excessive force being applied to a joint. The most common locations for a sprain to occur are:

  • the knee – which can become strained when a person turns quickly during sports or other physical activities
  • the ankle – which can become strained when walking or running on an uneven surfac
  • the wrist – which can become strained when a person falls onto their hand
  • the thumb – which can become strained during intense and repetitive physical activity, such as playing a racquet sport.

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 Symptoms of Foot  Sprain, Strain

  • pain,
  • swelling,
  • bruising,
  • instability of the joint, and
  • decreased range of motion.

Strains

A strain is an injury to a muscle and/or tendons. Tendons are fibrous cords of tissue that attach muscles to the bone. Strains often occur in your foot, leg (typically the hamstring) or back.

Similar to sprains, a strain may be a simple stretch in your muscle or tendon, or it may be a partial or complete tear in the muscle-and-tendon combination. Typical symptoms of a strain include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.

The severity of a muscle strain is graded into

  • First-degree strain – a mild strain when only a few muscle fibers are stretched or torn. The injured muscle is tender and painful but has normal strength.
  • Second-degree strain – a moderate strain with a greater number of injured fibers. There are more severe muscle pain and tenderness. There is also mild swelling, some loss of strength, and a bruise may develop.
  • Third-degree strain – this strain tears the muscle all the way through. There is a total loss of muscle function.
A severe hamstring injury where the tendon has been torn from the bone.

Soccer, football, hockey, boxing, wrestling, and other contact sports put athletes at risk for strains, as do sports that feature quick starts, such as hurdling, long jump, and running races. Gymnastics, tennis, rowing, golf and other sports that require extensive gripping, have a high incidence of hand sprains. Elbow strains frequently occur in racquet, throwing, and contact sports.

The recommended treatment for a strain is the same as for a sprain: rest, ice, compression and elevation. This should be followed by simple exercises to relieve pain and restore mobility. Surgery may be required for a more serious tear.

Contusions (Bruises)

A contusion is a bruise caused by a direct blow or repeated blows, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface. The discoloration of the skin is caused by blood pooling around the injury.

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Most contusions are mild and respond well with the RICE protocol. If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.

Causes of Strains

Strains can be caused by the following:

  •     Slipping on slick surfaces.
  •     Running, jumping or throwing during sports and activities.
  •     Lifting heavy objects.
  •     Participating in sports or activities without proper conditioning (muscles are not strong enough and flexibility may be limited; therefore you are more likely to sustain injury).
  •     Fatigue (tired muscles are less likely to provide support for the joints).
  •     Insufficient or improper warm-up (warming up before vigorous physical activity loosens the muscles and increases range of motion, making you less vulnerable to strains).

Signs and symptoms of strains include

  • pain,
  • inflammation,
  • muscle spasm,
  • muscle cramping,
  • muscle weakness, and
  • bruising may occur but may be delayed for several days.

Foot  Sprain, Strain

Diagnosis of Foot  Sprain, Strain

Strain injury (SI) may be diagnosed when symptoms develop after a repetitive task and fade when the task is stopped.

Your GP will examine the area where you have pain and ask about your symptoms and medical history.

If your symptoms suggest you have swollen and inflamed tissue, you may have an underlying medical condition, such as:

Bursitis

Bursae are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid and are positioned between bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is inflammation of a bursa. Repeated small stresses and overuse can cause the bursa in the shoulder, elbow, hip, knee or ankle to swell. Many people experience bursitis in association with tendinitis.

Foot  Sprain, Strain

Nerve entrapment, such as carpal tunnel syndrome

Dupuytren’s contracture – a thickening of the tissues in the hand, which causes one or more fingers to bend into the palm

Epicondylitis – inflammation of the area where bone and tendon join, such as the elbow

Rotator cuff syndrome – inflammation of the tendons and muscles around the shoulder

Tendonitis – inflammation of a tendon

Tiny tears in the Achilles tendon cause it to swell and thicken.

Tendinitis is an inflammation or irritation of a tendon or the covering of a tendon (called a sheath). It is caused by a series of small stresses that repeatedly aggravate the tendon. Symptoms typically include swelling and pain that worsens with activity.

Professional baseball players, swimmers, tennis players, and golfers are susceptible to tendinitis in their shoulder and arms. Soccer and basketball players, runners, and aerobic dancers are prone to tendon inflammation in their legs and feet.

Tendinitis may be treated by rest to eliminate stress, anti-inflammatory medication, steroid injections, splinting, and exercises to correct muscle imbalance and improve flexibility. Persistent inflammation may cause significant damage to the tendon, which may require surgery.

Removal (excision) of the bursa can be done using a standard incision (open procedure), or as an arthroscopic procedure with small incisions and surgical instruments. Your doctor will talk with you about the best procedure for your medical needs.

Tenosynovitis – inflammation of the sheath that covers the tendons, most commonly in the hand, wrist or forearms

Trigger finger – were swelling in a tendon running along one of the fingers makes it difficult to either bend or straighten the affected finger

Ganglion cyst – a sac of fluid that forms around a joint or tendon, usually on the wrist or fingers

Raynaud’s phenomenon – a condition where the blood supply to extremities such as the fingers is interrupted, especially when exposed to cold

Thoracic outlet syndrome – compression of the nerves or blood vessels that run between the base of the neck and the armpit

Writer’s cramp (a type of dystonia) – a condition that occurs from overuse of the hands and arms

If your symptoms don’t immediately suggest one of the above conditions, you may be referred for further tests

When diagnosing a strain or sprain, your GP will ask you about how you injured yourself. They will also ask you about any treatments that you have already tried, as well as any medication that you are currently taking that could affect the injury, such as anticoagulants (blood-thinning medication).

Your GP will examine the affected joint or muscle in order to assess how severe your injury is. For example, they will check for:

  • pain, discomfort, and tenderness in the injured area
  • swelling and inflammation
  • any lumps and bumps that are not usually present
  • bruising or bleeding in the joint or muscle
  • how much you can move the injured joint or muscle
  • whether you are able to put your weight on it

If you have a severe sprain, your GP may check whether the ligaments are loose instead of tight. This is sometimes called joint instability, mechanical instability or ligamentous laxity.

X-rays

Most people with sprains and strains do not need to have X-rays. However, your GP may recommend that you have an X-ray if:

  • you are unable to put any weight on your ankle, foot or leg
  • there is tenderness of the bones at specific points on your ankle, foot or leg
  • you have difficult moving your knee

Your GP may also recommend that you have an X-ray if you are over 55 years of age, and you have an acute knee injury (see below). The reason for this is that older people over the age of 55 have a higher risk of developing a fracture after this type of injury.

An acute knee injury is where the knee joint receives a sudden blow or is damaged in some other way, such as being suddenly twisted out of position.

Glossary

Joint
Joints are the connection point between two bones that allow movement.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
MRI
MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.
Swelling
Inflammation is the body’s response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Treatment for sprains and strains

Most soft tissue injuries take a few weeks to heal, depending on the severity of the sprain or strain, any subsequent injuries or issues such as weakness, stiffness, poor balance or function, and the general health of the person.

Foot  Sprain, Strain

First aid for sprains or strains

Suggestions for immediate treatment of acute sprains or strains include:

  • Stop your activity.
  • Rest the injured area.
  • Use ice packs every two hours, applied for 15 minutes and separated from the skin by wet toweling.
  • Compressor bandage the injured site firmly, extending the wrapping from below to above.
  • Elevate (raise) the injured area above heart height whenever practical.
  • Avoid exercise, heat, alcohol, and massage, which can exacerbate swelling.
  • If symptoms get worse in the first 24 hours, see your doctor for further medical investigation.

PRICE

  • Protect from further injury (for example, protect the ankle by support or high-top high-lace shoes).
  • Rest the joint for 48-72 hours following injury. For example, consider the use of crutches when wanting to be mobile. You need to protect the injured ankle from further injury. For example, use a bandage and/or ankle support, or a boot with high sides. It is important that the ankle is not rested for too long as this may delay recovery. In most cases, early controlled weight-bearing with the ankle well supported is preferable to complete rest.
  • Ice should be applied as soon as possible after injury, for 10-30 minutes. (Less than 10 minutes has little effect. More than 30 minutes may damage the skin.) Make an ice pack by wrapping ice cubes in a plastic bag or towel, or by using a bag of frozen peas. Do not put ice directly next to skin, as it may cause ice burn. Gently press the ice pack on to the injured part. The cold is thought to reduce blood flow to the damaged ligament. This may limit pain, inflammation and bruising.
  • Compression with a bandage will limit swelling and help to rest the joint. A tubular compression bandage or an elastic bandage can be used. The bandage should not be too tight – mild pressure that is not uncomfortable and does not stop blood flow is the aim. A pharmacist will advise on the correct size. Remove the bandage before going to sleep. You may be advised to remove the bandage for good after 48 hours so that the joint can move.
  • Elevation aims to limit and reduce any swelling. For example, keep the foot up on a chair to at least hip level when you are sitting. (It may be easier to lie on a sofa and to put your foot on some cushions.) When you are in bed, put your foot on a pillow
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Avoid HARM for 72 hours after injury

That is, avoid

  • Heat – for example, hot baths, saunas, heat packs. Heat encourages blood flow which will tend to increase bruising and inflammation. So, heat should be avoided when inflammation is developing. However, after about 72 hours, no further inflammation is likely to develop and heat can then be soothing.
  • Alcohol, which can increase bleeding and swelling and decrease healing.
  • Running, which may cause further damage.
  • Massage, which may increase bleeding and swelling. However, after 72 hours, gentle massage may be soothing.

Treatment may include

  • exercises, under the guidance of your doctor or another health professional, to promote healing, strength, and flexibility
  • manual techniques, such as mobilization and massage
  • electrotherapy
  • gradually introducing activities to back-to-normal levels.

Pain-relieving medication (talk to your doctor or pharmacist before taking any medications, as they can sometimes disrupt the healing of soft tissue injuries)

  • medication – including short-term use of anti-inflammatory painkillers (such as ibuprofen) or pain receptor-blocking medications, such as some forms of antidepressants, if you’re getting severe symptoms or interrupted sleep
  • cold packs, elastic supports or a splint
  • physiotherapy – including advice on posture and stretches or exercises to help strengthen or relax your muscles
  • steroid injections to reduce inflammation in an affected area (these are only recommended if an area has definite inflammation caused by a specific condition, such as carpal tunnel syndrome)
  • surgery to correct specific problems with nerves or tendons (for example, if you are diagnosed with carpal tunnel syndrome or Dupuytren’s contracture) if other treatments haven’t helped

Physical and complementary therapies

“Hands-on” therapies, including physiotherapy, massage or osteopathy, may be available after a referral from your GP, but in some cases, there may be a long wait for an appointment.

If you’re thinking about private treatment, make sure your therapist is registered with a professionally recognized organization.

Many long-term sufferers of RSI try other types of complementary therapies and relaxation techniques to help relieve the symptoms of RSI, such as:

  • yoga
  • acupuncture
  • the Alexander technique

Severe injuries, where the tissue has completely ruptured, may need surgery to put the torn pieces back together. Surgically repaired grade III injuries will require significant treatment to regain strength and function. Whether you have surgery, or immobilization and physical therapy, as the treatment for a grade III injury, medium to long-term success is similar for either treatment.

Prevention for Foot  Sprain, Strain

Injuries often occur when people suddenly increase the duration, intensity, or frequency of their activities. Many soft-tissue injuries can be prevented through proper conditioning, training, and equipment. Other prevention tips include:

  • Use proper equipment – Replace your athletic shoes as they wear out. Wear comfortable, loose-fitting clothes that let you move freely and are light enough to release body heat.
  • Balanced fitness – Develop a balanced fitness program that incorporates cardiovascular exercise, strength training, and flexibility. Add activities and new exercises cautiously. Whether you have been sedentary or are in good physical shape, do not try to take on too many activities at one time. It is best to add no more than one or two new activities per workout.
  • Warm up – Warm up to prepare to exercise, even before stretching. Run in place for a few minutes, breathe slowly and deeply, or gently rehearse the motions of the exercise to follow. Warming up increases your heart and blood flow rates and loosens up other muscles, tendons, ligaments, and joints.
  • Drink water – Drink enough water to prevent dehydration, heat exhaustion, and heat stroke. Drink 1 pint of water 15 minutes before you start exercising and another pint after you cool down. Have a drink of water every 20 minutes or so while you exercise.
  • Cooldown – Make cooling down the final phase of your exercise routine. It should take twice as long as your warm up. Slow your motions and lessen the intensity of your movements for at least 10 minutes before you stop completely. This phase of a safe exercise program should conclude when your skin is dry and you have cooled down.
  • Stretch – Begin stretches slowly and carefully until reaching a point of muscle tension. Hold each stretch for 10 to 20 seconds, then slowly and carefully release it. Inhale before each stretch and exhale as you release. Do each stretch only once. Never stretch to the point of pain, always maintain control, and never bounce on a muscle that is fully stretched.
  • Rest – Schedule regular days off from vigorous exercise and rest when tired. Fatigue and pain are good reasons to not exercise.
  • Avoid the “weekend warrior” syndrome – Try to get at least 30 minutes of moderate physical activity every day. If you are truly pressed for time, you can break it up into 10-minute chunks.

In additional that help prevent sprains and strains, you can

  • Avoid exercising or playing sports when tired or in pain.
  • Eat a well-balanced diet to keep muscles strong.
  • Maintain a healthy weight.
  • Try to avoid falling (for example, put sand or salt on icy spots on your front steps or sidewalks).
  • Wear shoes that fit well.
  • Get new shoes if the heel wears down on one side.
  • Exercise every day.
  • Be in proper physical condition to play a sport.
  • Warm up and stretch before playing a sport.
  • Wear protective equipment when playing.
  • Run on flat surfaces.

Ayurvedic Treatment for Foot  Sprain, Strain

  • Complete rest is advised. You should not walk with a sprained ankle. Use crutches, if the movement is a must.
  • A cold compression with ice can be done for some time, especially when your foot is not elevated.
  • Have a lot of ghee with figs and dates to build tissue and energy in your body.
  • Eat blanched and peeled almonds for energy. Remove the skin as it might contain toxins.
  • Drink plenty of hot water to remove ‘ama’ (toxins) from your body.
  • Place a teaspoon of black coffee in a bandage which you wrap around the injured foot.
  • Soak the outer leaves of cabbage in water. Then, wrap these soaked leaves around the ankle for 10-15 minutes for prompt relief.
  • Soak your ankle in a bowl of warm water with lavender oil added to it.
  • Massage the sprained ankle with a mixture of almond oil and garlic oil. This will increase the blood circulation in the region.
  • Boil nirgundi or karjana leaves after wrapping them in a cotton cloth. Apply this to the sprained ankle. Repeat the process for relief.
  • Put chopped onions in a muslin cloth and wrap it around the ankle for relief.
  • Massage the injured area with a mixture of sunflower oil and camphor oil to soothe the pain.
  • Include pineapples in your diet to aid the healing process.
  • To get relief from intense pain drink a glass of warm milk with some turmeric powder added to it. Turmeric is known to have antiseptic properties.
  • Massage the affected area with a teaspoon of honey and lime juice.
  • To heal the sprain, apply a paste of lime leaves and butter. Leave it on for some time.
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Home Remedies for Foot  Sprain, Strain

Lavender oil 

  • When you suspect that you have experienced a strain or a sprain, it helps to take quick action. The following simple techniques, if used immediately after the injury, will promote faster healing and can greatly reduce the amount and the duration of pain.
  • Caution: If you experience severe pain, significant swelling, discoloration at the site, get to a doctor as soon as possible. Be especially careful with injuries to the wrist or the ankle; these body parts are relatively delicate and vulnerable to fractures.”

Lettuce 

  • That Caesar salad you’re eating may be more than a tasty lunch. Lettuce’s anti-inflammatory effects make it a good topical remedy for simple sprains and strains, you might want to nibble a few leaves, too. Lettuce is rich in lactucin, a calming alkaloid and it has sedative properties. Chop up a few cold lettuce leaves, apply to the sprained area, and wrap loosely in an elastic bandage. Change the poultice when it grows hot.

Clove oil

  • Applying clove oil over the affected muscles will also relieve the pain and help in speedy recovery. Make the clove oil hot and then allow it to cool down for some time and then apply it over the painting muscles.

Garlic oil

  • Applying garlic oil over the inflammatory muscles will give relief from the inflammation, as garlic has anti-inflammatory properties. Garlic oil is also an important remedy for treating arthritis and rheumatism.

Sesame Oil

  • Applying sesame oil over the spraining muscle is also one of the very effective home remedies for muscle strain. Add one teaspoon of pepper powder in sesame oil and heat the oil for some time and apply it to the affected part. A tablespoon of pepper powder fried in sesame oil until it is charred can be applied as an analgesic liniment for muscle strain

Comfrey oil

  • Massaging the affected area with comfrey oil or cream can help in alleviating the pain.

Thyme oil compress

  • Five drops of thyme oil diluted either in bathwater or some other oil can be used as a compress to get rid of the swelling.

Arnica Balm Compress

  • Arnica balm or ointment can be used as a cream or a compress for the affected area.

Horse Chestnut

  • Horse chestnut is also very useful for such injuries. Due to its anti-inflammatory properties and presence of a compound called aescin, it becomes beneficial for all kinds of injuries. You can spread this gel on the affected area every two hours till the pain subsides.

Treatment with Diet

  • You might not think of diet as an important part of healing an injury, but good nutritional choices in weeks following a sprain or a strain can speed your recovery and reduce your pain.

Increase intake of protein

  • You need lean protein to rebuild strong elastic muscles and ligaments. Eat reasonable amounts of chicken, turkey, and fish and incorporate beans into your meals.

Antioxidant

  • Colored vegetables for memory improvement. An injury can result in the formation of free radicals, the unbalanced molecules that are thought to be responsible for many diseases. Combat free radicals with the antioxidants found in deeply colored fruits and vegetables.

Vitamin C

  • Vitamin C will help to reduce swelling and repair tissues, eat citrus fruits as a light dessert.

Keep Rest 

  • Avoid putting weight on an injured joint or muscle, but do keep it mobile. After the swelling is down and any acute pain has passed, try to work the body part through its range of motion, this will help prevent stiffness.

Use Aromatherapy

  • Lavender oil for muscle sprains and strains. After the swelling has subsided, try a combination of eucalyptus, peppermint, and lavender oils to stimulate a nourishing flow of blood to the injured area and reduce pain. You can use these oils in a warm bath or a compress.

Reduce Stress

Usually, for an active person, it can be terribly frustrating to spend days or even weeks laid up with an injury. Try some chamomile tea to calm your nerves.

Homeopathy for Foot  Sprain, Strain

  • Sarnia for inflammation. Pick the remedy that best matches your symptoms in this section. For acute strains/sprains take a 30 C potency four times daily. For chronic sprains/strains that have not healed, take a 6x. 12x. 6c. 12c. or 30c twice daily, for two weeks, to see if there are any positive results. After you notice improvement, stop taking the remedy. unless symptoms return. Consultation with a homeopathic practitioner is advised”

Arnica Montana

  • Is helpful at the beginning of an injury, when there is bruising and swelling.

Bryonia Alba

  • Should be used when there is pain from any movement. The person feels irritable from the pain.

Calcarea Fiuorica

  • Is indicated for chronic sprains and strains that do not heal, or for people who are susceptible to getting these types of injuries due to weak ligaments or tendons.

Ledum Palustre

  • Is for sprained ankles or knees that are swollen and that Feel better with ice applications.

Rhus Toxicodendron

  • Should be used for injuries that cause stiffness, especially during the first movement, but that loosen up later in the day. The injury feels better from warm applications.

Ruta  graveolens

  • Is for overused ligaments and sprains that result in swelling and a lame feeling in the joint.

References

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